Contemporary diagnosis and treatment of severe pancreatic necrosis complications

Surgery Department II, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The last years are characterized by a considerable increase of frequency of acute pancreatitis which ranks third (6-9 %) out of the number of patients with acute surgical pathology of abdominal cavity, yielding to appendicitis and acute cholecystitis. Destructive forms of acute pancreatitis are considered one of the most difficult problems of gastroenterological surgery because of its high mortality rates, ranging between 25 – 50 % and more. The appraisal of complex diagnostic principles of severe pancreonecrosis. The appraisal of optimal methods of surgical treatment; and analysis of severe pancreonecrosis treatment results; and its complications in the early postoperative period. Materials and methods: We present the clinical material which includes the analysis of 22 patients diagnosed with severe pancreonecrosis treated at The Emergency Medicine Institute, in Septicpurulent Surgery during 2012-2015. Discussion results: The clinical state of these patients was dominated by pain syndrome, presented at 22 patients (100%), being the first clinical symptom. Afterwards, the dyspeptic syndrome appeared at 18 patients (81 %). The patients’ state at the moment of internment was assessed as being extremely critical at 6 (27%) patients, critical at 10 (45) patients, medium severity at 6 (27 %) patients. The diagnosis of pancreonecrosis was made on the basis of objective and subjective data, laboratory data, and methods of invasive and non-invasive investigation. Pancreonecrosis diagnosis was assessed based on ultrasound imaging at 12 patients (54,4%), based on computer tomography with intravenous contrast material at 8 patients (36,3%), based on laparoscopy at 2 patients (9%). The strategy of surgical treatment of complications caused by pancreonecrosis of all 22 patients consisted in necro-sequestrectomy, drainage of the lesser sac, bursoomentostomy at 21 patients (95%). Cholecystectomy was conducted in 6 patients (27%). Conclusions: The diagnostic algorithm of patients suffering from pancreonecrosis will compulsorily include clinical and biochemical analysis, ultrasound, computer tomography. Also, patients require special surgery treatment, necro-sequestrectomy and drainage of the lesser sac

Diagnosis and treatment of esophageal diverticula complications

Surgery Department II, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The modern diagnosis and treatment of the complications caused by esophageal diverticula represent a major and little-studied problem of nowadays thoracic surgery. Generally, the actuality of this problem is closely related to its rare incidence within the pathology of alimentary duct, and particularly within the pathology of esophagus. The incidence of esophageal diverticula occurs at a frequency of 0,01% - 0,11% in the USA. Usually, it befalls between the 7th and 8th decade of a man life, and rarely before 40. This disease more frequently affects people living in Northern Europe. The appraisal of complex diagnosis principles of complications caused by esophageal diverticula. The appraisal of optimal methods of surgical treatment; and analysis of esophageal diverticula treatment results; and its complications in the early postoperative period. Materials and methods: We present the clinical material which includes an analysis of 32 patients diagnosed with esophageal diverticula treated at The Republican Clinical Hospital, in Thoracic Surgery during 2010-2015. Discussion results: The clinical state of these patients was dominated by severe dysphagia symptomatology, presented at 26 of the patients (81.25%), 6 (18.75%) patients had regurgitations. 13 of the patients (40%) presented symptoms of dyspnea, retrosternal pain and weight loss. The patients’ state at the moment of hospitalization was assessed as being critical at 8 patients (25%), and medium severity at 24 patients (75%). The diagnosis of esophageal diverticula was made on the base of objective and subjective data, laboratory data, and methods of invasive and non-invasive investigation. The diagnosis was assessed after a digestive barium swallow examination of all 32 patients (100%) and in combination with upper digestive endoscopy of 8 (25%) patients. The strategy of surgical treatment of esophageal diverticula of all 32 patients consisted in diverticulectomy with surgical approach depending on the diverticulum localization. Postoperative evolution was favorable. The postoperative examinations which included meticulous anamnesis and imagistic examinations (digestive barium swallow, upper digestive endoscopy) had good results; it means improvement of symptomatology and a definite recovery of the esophageal wall.Conclusions: Esophageal diverticulum, even if is a “benign” disease requires complex surgical procedures, encumbered with significant mortality and morbidity, the postoperative complication are redoubtable and difficult to control. The diagnosis is assessed by subjective complaints and easily confirmed thanks to imagistic examinations such as digestive barium swallow and upper digestive endoscopy. Surgical indications must be carefully set after a thorough clinical and laboratory examination

Turkey's rapprochement with Russia: Assertive bandwagoning

Despite Russia’s increasing clout and assertiveness in its region, Turkey has chosen to improve its relations with Russia, rather than balance against it through its Western allies. Turkey’s unexpected strategic partnership with Russia is best seen as an example of bandwagoning for profit. It is an assertive bandwagoning with the objective of counter- ing Kurdish separatism, an imminent problem in the Turkish ruling elite’s ranking of threat perceptions. The empowerment of Syrian Kurdish groups under the protection of the United States has moved Turkey closer to Russia. A long-term alliance between the two, how- ever, depends on reconciliation of their differences which are deeply rooted in historical and geo-political factors

Early-onset and late-onset Alzheimer’s disease are associated with distinct patterns of memory impairment

The goal of this study was to investigate the specific patterns of memory breakdown in patients suffering from early-onset Alzheimer’s disease (EOAD) and late-onset Alzheimer’s disease (LOAD). Twenty EOAD patients, twenty LOAD patients, twenty matched younger controls, and twenty matched older controls participated in this study. All participants underwent a detailed neuropsychological assessment, an MRI scan, an FDG-PET scan, and AD patients had biomarkers as supporting evidence of both amyloïdopathy and neuronal injury. Results of the neuropsychological assessment showed that both EOAD and LOAD groups were impaired in the domains of memory, executive functions, language, praxis, and visuoconstructional abilities, when compared to their respective control groups. EOAD and LOAD groups, however, showed distinct patterns of memory impairment. Even though both groups were similarly affected on measures of episodic, short term and working memory, in contrast semantic memory was significantly more impaired in LOAD than in EOAD patients. The EOAD group was not more affected than the LOAD group in any memory domain. EOAD patients, however, showed significantly poorer performance in other cognitive domains including executive functions and visuoconstructional abilities. A more detailed analysis of the pattern of semantic memory performance among patient groups revealed that the LOAD was more profoundly impaired, in tasks of both spontaneous recall and semantic recognition. Voxel-Based Morphometry (VBM) analyses showed that impaired semantic performance in patients was associated with reduced gray matter volume in the anterior temporal lobe region, while PET-FDG analyses revealed that poorer semantic performance was associated with greater hypometabolism in the left temporoparietal region, both areas reflecting key regions of the semantic network. Results of this study indicate that EOAD and LOAD patients present with distinct patterns of memory impairment, and that a genuine semantic impairment may represent one of the clinical hallmarks of LOAD

The effect of age on the FCSRT-IR and temporary visual memory binding

ABSTRACT: Background:Cognitive markers of early Alzheimer's disease (AD) should be sensitive and specific to memory impairments that are not associated with healthy cognitive aging. In the present study, we investigated the effect of healthy cognitive aging on two proposed cognitive markers of AD: the Free and Cued Selective Reminding Task with Immediate Recall (FCSRT-IR) and a temporary visual memory binding (TMB) task. METHOD: Free recall and the cost of holding bound information in visual memory were compared between 24 younger and 24 older participants in a mixed, fully counterbalanced experiment. RESULTS: A significant effect of age was observed on free recall in the FCSRT-IR only and not on the cost of binding in the TMB task. CONCLUSIONS: Of these two cognitive markers, the TMB task is more likely to be specific to memory impairments that are independent of age

Abnormalities of saccadic eye movements in dementia due to Alzheimer's disease and mild cognitive impairment

Background: There is increasing evidence that people in the early stages of Alzheimer's disease (AD) have subtle impairments in cognitive inhibition that can be detected by using relatively simple eye-tracking paradigms, but these subtle impairments are often missed by traditional cognitive assessments. People with mild cognitive impairment (MCI) are at an increased likelihood of dementia due to AD. No study has yet investigated and contrasted the MCI subtypes in relation to eye movement performance. Methods: In this work we explore whether eye-tracking impairments can distinguish between patients with the amnesic and the non-amnesic variants of MCI. Participants were 68 people with dementia due to AD, 42 had a diagnosis of aMCI, and 47 had a diagnosis of naMCI, and 92 age-matched cognitively healthy controls. Results: The findings revealed that eye-tracking can distinguish between the two forms of MCI. Conclusions: The work provides further support for eye-tracking as a useful diagnostic biomarker in the assessment of dementia